Is marijuana the Holy Grail for pain medication?

Is marijuana the Holy Grail for pain medication? You might think so by reading the popular press.

An ideal drug therapy is one that is highly effective for a multitude of pain disorders and has low to no toxicity regardless of duration of exposure. Marijuana flirts with this profile—but it is a Trojan horse.

Depending on where you live, it may be legal for you to get a prescription for marijuana. But before you rush to your doctor’s office with your request, remember that all drugs have risks. It is a clinician’s responsibility to evaluate the potential benefit, relative to the potential risk, of each drug option. Marijuana products have fewer risks than opioids. Still, marijuana should be used judiciously and with awareness that it could be harmful.

Here are five things to think about:

• Marijuana is a plant, not a drug, and it has many active chemicals. We need to know which of the chemicals are therapeutic, and for which specific pain diseases, and at what doses.

• Some people get addicted. A small percentage of people who use marijuana get hooked on it. The younger you start, the more likely you are to become addicted. Children or adolescents who use marijuana are more likely than most adults to develop an addiction.

• Tetrahydrocannabinol (THC) alters brain function. There was once a lot of hype, fed by Hollywood, about how marijuana can drive a person insane. Most of that was exaggeration and even false. It’s true, however, that tetrahydrocannabinol can override your ability to feel sensation, reduce your access to memories, restrict your ability to move, and even trigger psychosis. Marijuana users today are at greater risk of side effects than those in the past because of the increased potency of THC in recent years.

• Long-term use can be problematic. Using marijuana over time can cause mental health problems for many. Even those who do not become addicted can experience hallucinations and paranoia. Some users can experience anxiety, depression, and even suicidal tendencies. Also, teens’ use of marijuana can interfere with the healthy development of their brain. And for pregnant women, marijuana use could affect the brain of their fetus.

• Marijuana increases heart and breathing problems. TCH, the same chemical in marijuana that affects your brain, can also adversely affect your heart. It has been linked to heart attacks in adults. Smoking marijuana can lead to many of the same breathing problems, including lung infections and coughing, as smoking cigarettes.

The point to remember is that all drugs used to treat disease, including chronic pain, come with risks. That means our approach to drug therapy should be thoughtful and wide eyed, not blind. I am not making an argument against marijuana but rather am encouraging greater understanding of marijuana’s potential risks.

Considering the current opioid crisis, marijuana may be a safer alternative in some clinical situations. But we must be aware of the potential harm if it is used. Although marijuana may offer a solution to some people with pain, it is not the Holy Grail of analgesics.

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Dr. Lynn R. Webster, MD, is the Past President of the American Academy of Pain Medicine, Vice President of Scientific Affairs at PRA Health Sciences, and author of a book, The Painful Truth, and producer of a PBS TV documentary by the same name. Visit him online at www.thepainfultruthbook.com. He lives in Salt Lake City.